MED3000 Guide

Remember when you were learning to drive? Remember how you wanted nothing more in the whole world than to pass your test? At last, you thought, I can be free, I can be a grown up! So you practised and you logged hours and yes finally you passed! Then the next day you got behind that wheel and it hit you: “OMG, I have to drive now. By myself!” Suddenly 40Kph seemed *really* fast. No, just me? Ok. Well the point is that now you’ve made it! You’ve completed your pre-clinical years and, yup, you need to get behind that wheel and drive the car. Patient. Whatever.

The key point here is that everything is new, everything is different but thankfully we’ve got some great advice from the class of 2014 to help us along and ease our transition from the PBL room to the ward.

Looking back, what is the number one piece of advice you’d give to someone about to start their first rotation?

Show interest and take advantage of every opportunity. Volunteer to do things if you are given the chance and if there is something you really want to try (e.g. cannulation, intubation etc) then make sure you ask whilst still giving the doctor a chance to say no. My trick was to say something like “If there is a suitable patient it would be great if I could have a go at….” – this way you have shown interest but if they don’t feel comfortable supervising you they can say “sorry, there were no suitable patients. – Hannah

Forget PBLs. This is the real world. Apply your pre-clinical knowledge to the clinical scenarios. Speak when spoken to. Ask questions only at times when interns/regs/consultants are not busy – and ask relevant questions. Use your holidays to read up/watch medical shows to gain a grasp of common terminology and abbreviations thrown around the on the wards.

Listen to and, take note of, the discipline Head (discipline leader) RE what is expected of you during the rotation. I know it sounds like common sense but it’s true.
Ease yourself into the rotation.

Make the most out of your clinical placements by taking advantage of your hospital access. The most rewarding experiences and opportunities of med 3000 came to me from being at the hospital with nothing in particular to do. Often, I would be contemplating going home, when by chance I would see a familiar doctor/ nurse/ registrar/ intern whom I’d ask if there was anything I could do. This willingness to get involved would lead me to doing all kinds of interesting things such as assisting in a neck dissection, witnessing an emergency tracheostomy, intubating a patient or stitching the head of an injured man. It even led me to gain some valuable research experience which would eventually help me secure a student research project for med 4000.

Take time to familiarise yourself with the environment and follow the consultants plans through from inception to delivery. For example, on surgical term, choose a patient whom you have taken a through history and have built good rapport. Follow them through each stage of their hospital stay. Accompany them at the bedside from admission to diagnostic testing, pre-op assessment, anaesthetics, theatre, post-op recovery and the back to the ward. This will give you a great understanding of what it is like to be the patient, improving your ability to relate and be empathetic with their concerns and frustrations.

The process is amazingly complicated and you can only appreciate all the intricacies once you’ve followed through every part of the chain. There are also lots of procedures an protocols you will not find in your text books that you will exposed to.

Come in early (about 15 min) to meet your team (residents and regs) before the consultant comes in. If the team isn’t there yet, introduce yourself to the nurses. You will need their help this year. Ask them if they have a ward list you can borrow if you haven’t yet worked out how to print yours. Helps keep track of conditions. Have MIMS on your iPhone as soon as you have access to CIAP. you will need it! – Ang

How did you make the most of your experience at this clinical school?

Having good attendance! In the rotations where I showed up the most and built a rapport with the team I was given much more responsibility. – Hannah

I tried to do the same shift/times as my intern/GP/consultant.

Attending the extra-curricular events that Prof Lal organised e.g. medical meetings on a Wednesday morning and surgical meetings on a Wednesday (with lunch provided) etc. Self-directed reading regarding things that may or may not have been a LO. This helped with broadening my knowledge.

Attend ward handovers from the nursing staff (especially important for O&G) and listen to the information that is conveyed amongst the team. This was very handy for when we as medical students we were on the medical ward round with the Consultant whom expected you to have reviewed the patient notes, seen the patient and have a relevant update on their progress. Ensure that you are organised for your rotations. A classic example is for the surgical rotations. Ensure that you have attended OT and completed the Surgical Scrub certificate (there may be a more formal name for this certificate but I can’t recall the details) this will then make it easier if your Surgeon asks you to scrub and assist. ALWAYS REMEMBER TO EAT OR DRINK SOMETHING BEFORE THEATRE 🙂 Respect all of the staff.

Come in earlier than your consultant to view your patient list. This helps you to understand what is going on during rounds. Spend time in the emergency department. You get to take the histories, do the examinations, present cases, do the investigations and follow-up in the wards if they get admitted. It’s a great learning experience and there’s always doctors happy to help! Know how to interpret ECGs and CXRs, preferably before your medicine rotations. You will be doing a lot of interpreting in front of consultations.

How did you balance the demands of covering LO’s with your rotations?

By being organised! The hard part of MED3000 is that you have to get through the same amount (or more) of LO’s but mostly all outside of normal working hours. You also often get things to look up from the team you are on which need to be done also. Somehow by MED3000 you’ve figured out (mostly) how to get LO’s done efficiently so everyone balances it in the end. Don’t forget to prioritise other parts of your life (family, social) as well though – I found that I struggled with this at the beginning of the year until I prioritised it again and got some balance back. – Hannah

Attempted LOs during the Mondays. The rest of the week was for reading up on cases seen during the day.

It’s a marathon, just do the best you can. Spending time on the wards and seeing patients and attending rooms is very important and through wider reading you realise that you start to cover LO points without even realising.

Hard task. I prioritised my time at the hospital so covering Los took a back seat for most of the year.

Do all the Los for your rotation by about week 2-3. Keep up as best you can with the week but to be honest the rotation Los should be the priority.

What advice would you give to help survive on the wards?

Just accept that you won’t know the answer to lots of things – “I’m not sure, but I’ll look it up tonight” comes in handy (and then make sure you do look it up because they always ask you). Doctors ask you questions to help you learn not to make you look silly (though this happens mostly anyway – I was asked in theatre which lobe of the liver they were operating on and having seen the surgery on the theatre list for the day I confidently said “The 9th lobe” – there are only 8 lobes in the liver and I had read the roman numerals incorrectly). Don’t make it up if you are unable to elicit a clinical sign (I was asked to examine a patient with dextrocardia and was really embarrassed to admit I couldn’t hear any heart sounds on the left – luckily I didn’t lie and say dual heart sounds no murmur as her heart was in a completely different place!) Be nice to everyone, ask if you are not sure and be grateful when people help you out. Luckily if you’re at Vinnie’s Messina is very close by. My group often had emergency Messina runs if someone was having a bad day.

Know the patients or at least their treatment regimes. Observe what the interns/regs do and help out on scribing or any other duties the intern might need help in. Ask them to delegate if the team is big.

When cannulating, take enough equipment for 2 attempts (so you don’t have to go back and forth getting things if you miss). If the patient is anxious about a medical student doing it, tell them that you will have 2 attempts and that if you miss them then you will get someone else to do it. Knowing that there weren’t going to be endless attempts by a novice seemed to relax most patients and increases your chance of cannulation success!

Survive’ is a good way to put it. I still don’t feel 100% comfortable on the ward. If you are by yourself, I would recommend the following: Introduce yourself always, Clearly state your level, Don’t act above your level, Ask if there is anything you can help with , Remember the names of those working on the ward, Don’t get in the way!

Arrive early, have MIMs on your phone, know the ward list and the background of each patient on it. Girls get one of those clutches that has a long strap to go across your body so that you can carry things easily. We all had one.

Start your day early at the hospital – be there as many days you can be for rounds, then leave EARLY! (Unless you are scheduled for something)… Make sure you have 2-3 hours, ie from 2pm to do your LOs most days. If you spend from 7-8am on ward most days for 5-6hrs you should be in good shape. – Karyn

Some final words of wisdom:

Enjoy! MED3000 is challenging on lots of levels but it is amazing being able to interact with patients and it is really surprising how quickly your skills develop. Maintain a balance with the rest of your life – it’s easy to let med take over. It becomes easier to learn Los when you are seeing patients because as soon as you see a patient with a condition you remember the risk factors, presentation investigations and treatment, side effects etc. – Hannah